4 Gates of Speech

Your professional ethics support you when you lean on them with skillful speech. Professional behavior takes you on the “high road” by employing integrity. As a professional you are honest, do no harm, competent, accountable, and self-regulated. As health care budgets are cut and more work is expected of fewer nurses, speaking up for justice and ethical behavior is not always easy. 3.6 million nurses strong, the profession has resources to keep you on track to have a strong ethical voice when it comes to health care issues.

Comparing current events to the rise of Nazism and Fascism in the 1930’s, Yale Professor Timothy Snyder reminds us in On Tyranny: 20 Lessons from the 20th Century, “when political leaders set a negative example, professional commitments to just practice become more important…. If members of professions think of themselves as groups with common interest, with norms and rules that oblige them at all times, then they can gain confidence and indeed a certain kind of power.” (p. 40) In 2015 the ANA took an unequivocal stand on the issue of incivility and bullying in the work place. Nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect.” Similarly, nurses must be afforded the same level of respect and dignity as others (ANA, 2015a). The ANA has also taken a thoughtful and strong stand on health care reform.

Although there are no federal standards that require workplace violence protections, several states have enacted legislation or regulations aimed at preventing workplace violence. What does your state have in place? You need strength and clarity to stand up for yourself and others when in a toxic situation of incivility or bullying. The 4 Gates of Speech will guide and support your ethical behavior when you are told the situation is exceptional, or you are asked to do something that is immoral and puts your license at risk.

4 Examples:

I was a hospice nurse in a rural area. The company was having many different economic and staffing difficulties. My census was increased to way beyond what was safe or reasonable.

With some trepidation, I explained to my supervisor that I could not take the next admission because it was not safe for me or for the patient. The admission was given to another team. Safe RN ratios have been proven to improve the quality of care and nurse recruitment and retention in California hospitals which is the only state that has mandated nurse/patient ratios. My experience of speaking up to my supervisor was very empowering. It also was a good example to my peers.

2. An APRN colleague recently relayed the following experience: After her report in the monthly meeting, the supervisor criticized her in front of the team such that she felt “shamed, embarrassed, humiliated and undermined”. The APRN later went to the supervisor. She explained to her that if she had a criticism, she should tell her privately. The supervisor has not humiliated the APRN since, but continues her uncivil and bullying behavior with others.

Our beautiful profession of nursing is about reducing suffering and building on strengths towards increased well being for nurses as well as those in our care. Using the 4 Gates of Speech you can confront difficult situations with clarity and confidence.

Is it true? Is it necessary? Is it kind? Is it the right time and place?

Using these gates let’s unpack the APRN’s situation. We don’t know if the criticism was true or was necessary. However, the supervisor clearly chose the wrong time and place and was not kind. The APRN spoke her truth to establish her professional boundaries and consequently was teaching the supervisor how to behave professionally. She did not share her feelings of being undermined, shamed and embarrassed. (Under other circumstances sharing feelings might be useful.) The APRN found a place that allowed for privacy but we don’t know if the time was mutually satisfactory. The APRN spoke in a way that was professional, which is, kind and beneficial. Her speech and action set an example to prevent future occurrences of incivility to herself and others.

3. In the 1980’s I worked in a small city hospital that began to change its identity from a neighborhood hospital to a corporate model. Nurses’ benefits were cut and nursing positions were eliminated in addition to other cost cutting efforts at the expense of patient care.

It was the nurses’ professional behaviors- how we spoke to each other, what we said, where we said it, and the actions that followed that convinced reluctant nurses to reconsider their positions. Taking the “exceptional” stance: “just for now and the situation will change”, the cuts continued. The nurses discovered that advocating for their patients, they were also speaking on their own behalf. Eventually a nurses union was voted in and the nurses had a voice at the bargaining table and negotiated improvements on behalf of themselves and their patients. At the end the nurses remarked what an empowering learning experience it was for all.

4. More recently remember the arrest of University of Utah Hospital nurse Alex Wubbels on July 26, 2017. She was defending her patient’s right to not have his blood drawn without consent. It would have been an ethical breach to not have done so. Having to speak up to law enforcement officials, which can be difficult given their positions of authority and power, her actions have given everyone an excellent and extreme example of advocacy.

The bottom line is that if your license is at risk, you are facing an ethical dilemma.

When you see something that is not professional or right, do you deny it, turn away or stand up? What gives you that strength and courage to stand up for yourself and others? As you reflect on your career, please share with us your experiences of professional risk and how you handled it.

What you think and how you talk to yourself may not be audible to others, but does influence your deeds and words affecting not only you but others.“Don’t forget to turn off the lights, Honey”, read my friend’s note to herself at the door. The aha for me was that I could talk to myself the same way I talk to her, and it has been a rewarding process. The Sufi, Buddhist and the Yogic traditions offer us the 4 Gates of Speech to help us before we speak to ourselves and to others. I visualize these gates as sieves for effective communication that separate what is kind, true, necessary and beneficial from what is not.

Is it true?

Is it necessary?

Is it kind?

Is it the right time and place?

Do you talk to yourself the way you talk to your best friend? After all, you are part of your kindness, caring equation. When you make a mistake- do you speak kindly to yourself or do you call yourself names? Do you put yourself down? What is the tone of your inner voice to yourself? Is it kind, understanding and compassionate, or scolding and judging? Remember feelings may truly be there, but they may not be the truth of the matter. Do you tell yourself the truth about yourself? You may experience embarrassment or shame, but that does not mean you are bad or shameful. Strong feelings can be difficult to feel and can cause you to say things that you regret. So pausing and checking in with the 4 Gates of Speech can help you to not hurt yourself or others.

Mahatma Gandhi the great peace activist said, “speak only if it improves upon the silence”. Pausing before going through the 4 Gates of Speech, increases your awareness of your inner dialog which is a strong step in reducing suffering in you and in others. Like everything, it takes practice, so if you goof up saying something you regret you can use the 4 Gates to correct the message and without people pleasing. Like feathers out of the pillow, you cannot take the words back, but you can make your next words reflect having passed through the 4 gates. The gates are useful for recognizing not only content and time, but to whom you need to apologize.

These 4 Gates of Speech are protections that enhance your esteem. Becoming thoughtful about what you think and say and how you think and say it, you engage truth, kindness and sensitivity which decreases gossip and makes for friendlier personal and professional worlds for you.

I now write notes to myself with kindness. The alarm that reminds me when it is time to get ready for bed says, “Time to wind down, Dear.”

Healthy self talk is empowering and kind.

In the Vitality in Progress: Healing and Preventing Burnout for Nurses participants choose 3 keystone habits to practice. The topics of communication, boundaries, compassion and kindness are personalized through reflection, mentoring conversations and sharing circles. Participants explore their self talk and are encouraged to notice any negative self talk or behaviors.

In the meantime, join us on Wednesdays 6:30-7:00 pm EST

Self Care for Vitality

Free Virtual Connecting Weekly Call-in for Nurses

Phone 712-432-3066

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There is a short guided relaxation, followed by a short time for silence

in community and optional sharing

We present tips and strategies for Self care on a variety of topics such as:

Setting boundaries, balance, healing, self love, vulnerability, and other topics as they arise.

It’s free to all and you can join in with a share or just listen in.

Have a great week speaking kindly to yourself and others~

With love, Padma

Upcoming Events:

VITALITY IN PROGRESS

MAY 6 - JULY 28, 2018

RN’s and LPN’s who successfully complete the program can qualify for 39 CNE’s from the American Holistic Nurses Association which is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.